University of Alabama, Birmingham

NUR 388

1)A charge nurse is observing a newly hired nurse prepare a sterile field. Which of the following indicates to the charge nurse that the sterile field is contaminated?

2) A nurse is providing teaching to a client who is receiving chemotherapy. Which of the following client statements indicates an understanding of the teaching?

3. A nurse is evaluating a client who has right leg weakness and is learning to use a rubber-tipped standard walker. Which of the following actions by the client indicates proper use of the walker?

4. A nurse is caring for a client who has tuberculosis. Which of the following actions should the nurse take? (Select all that apply)

5. A nurse is transcribing new prescriptions for a client. Which of the following prescriptions is accurately transcribed by the nurse?

6. Which of the following precautions is important to take when a nurse is caring for a client who has diarrhea due to Shigella?

7. A nurse is preparing to insert an IV catheter into a client’s arm prior to initiating IV fluid therapy. Which of the following interventions should the nurse implement to prevent infection?

8. A nurse is caring for a client who is scheduled to be transferred to a long-term care facility. The client’s family questions the nurse about the reasons for the transfer. Which of the following responses made by the nurse is appropriate.

9. A nurse is providing discharge teaching for a client who has a new prescription for a home oxygen concentrator. Which of the following instructions should the nurse give to the client and his family?

10. Which of the following should indicate to a nurse the need to suction a client’s tracheostomy?

11. A nurse is performing a Romberg’s test during the physical assessment of a client. Which of the following techniques should the nurse use?

12. A nurse is preparing to obtain a lower extremity blood pressure from a client and no longer palpates the popliteal pulse after 92 mm Hg. Which of the following images displays the appropriate mm Hg to which the nurse should inflate the cuff when obtaining the blood pressure?

13. A nurse is reviewing the medical records for a client who has a pressure ulcer. Which of the following is an expected finding?

14. A nurse in a long-term care facility is planning to perform hygiene care for a new resident. Which of the following assessment questions is the nurse’s priority before beginning this procedure?

15. A nurse is planning to delegate client care to an assistive personnel (AP). Which of the following factors is most important for the nurse to consider before delegating care?

16. A nurse is providing teaching to a client about techniques to promote sleep. Which of the following instructions should the nurse include in the teaching?

17. A nurse is preparing to administer ampicillin 40 mg/kg/day PO divided in equal doses every 6 hr to a toddler who weighs 10 kg. Available is ampicillin oral suspension 125 mg/5mL. How many mL should the nurse administer per dose? (round to nearest whole number)

18. A nurse is caring for a client who has a prescription for wound irrigation. Which of the following actions should the nurse take?

19. A nurse is caring for a postoperative adult client who refuses to use an incentive spirometer following major abdominal surgery. Which of the following is the nurse’s priority action?

20. A nurse is caring for a client who has taken in 2,600 mL of fluids in 24 hr. Which of the following is expected output for the client?

21. A nurse is providing teaching about a clear liquid diet. Which of the following should the nurse instruct the client to avoid?

22. A nurse is completing an admission assessment of an older adult client. Which of the following findings is a potential indication of abuse?

23. A nurse is caring for a client in the immediate postoperative period. The nurse should recognize that which of the following positions maximizes the effectiveness of incentive spirometry.

24. A nurse is obtaining a health history from a client who has hearing loss. Which of the following actions by the nurse is appropriate?

25. A nurse is caring for a client who has dementia. Which of the following interventions should the nurse take to minimize the risk for injury to this client?

26. Which of the following techniques should the nurse use when performing nasotracheal suctioning for a client?

27. A nurse is caring for a client who is refusing a scheduled blood transfusion for religious reasons. The client’s partner wants the client to have the blood transfusion. Which of the following actions should the nurse take?

28. A nurse is caring for a client who has an NG tube that is irrigated every 8 hr. Which of the following should be used to irrigate the tube in order to maintain fluid and electrolyte balance?

29. A nurse is caring for a client with cancer who lives at home with her spouse. The spouse tells the nurse that the client is in pain “all of the time.” Which of the following actions is most important for the nurse to take?

30. A charge nurse is discussing the responsibility of nurses caring for clients who have Clostridium difficile. Which of the following information should the nurse include in the teaching?

31. A nurse is preparing to administer meperidine 80 mg IM from a 100 mg prefilled syringe. After the injection, which of the following is an appropriate action by the nurse?

32. A hospice nurse is providing end-of-life care to a client who has terminal lung cancer. The client states, “I am so tired and afraid of not being able to catch my breath.” Which of the following is an appropriate response by the nurse?

33. A nurse is caring for a client for whom a nasogastric tube is ordered for stomach decompression. Which of the following actions is appropriate when inserting the NG tube?

34. A nurse is caring for a client receiving fluid through a peripheral IV catheter. Which of the following findings at the IV site should the nurse recognize as infiltration?

35. A client is receiving continuous tube feeding via NG tube. The client has 3 episodes of vomiting in 12 hr. Which of the following actions should the nurse take?

36. A nurse is caring for a client who needs a 24-hr urine collection initiated. Which of the following client statements indicates an understanding of the procedure?

37. A nurse in a long-term care facility notes that a client coughs frequently during meals and suspects dysphagia. The nurse should assess the client for which of the following behavioral signs of dysphagia?

38. A nurse is reviewing practice guidelines with a group of newly licensed nurses. Which of the following interventions falls within the RN scope of practice?

39. A nurse is caring for a client who has left-sided paralysis after a cerebrovascular accident. The client is unable to bear his own weight. Which of the following actions is an appropriate method to move the client from his bed to his wheelchair?

40. A nurse has accepted a verbal prescription for three tenths of a milligram of levothyroxine IV stat for a client who has myxedematous coma. How should the nurse transcribe the dosage of this medication in the client’s medical record?

41. A nurse is assisting a client with range-of-motion exercises of the next. Which of the following should the nurse suggest to promote neck rotation?

42. A nurse is speaking with the parent of an infant who has a cardiac defect. After the parent expresses concern, which of the following is an appropriate response?

43. A nurse is preparing to transfer a client from the bed to the stretcher using a slide board. Which of the following actions should the nurse take?

44. A nurse is reviewing a protocol in preparation for suctioning a client who has a new tracheostomy. Which of the following is an appropriate action for the nurse to take?

45. A nurse is caring for a client receiving IV fluids. During a routine check, the nurse determines that the client has developed phlebitis and removes the IV catheter. Which of the following actions should the nurse take next?

46. A nurse is reinforcing teaching regarding the use of a cane to a client who has left-leg weakness. Which of the following should the nurse include in the teaching?

47. A nurse is caring for a client who is having difficulty voiding following the removal of an indwelling urinary catheter. Which of the following actions should the nurse take?

48. A nurse is preparing a change-of-shift report. Which of the following is an appropriate method to communicate continuity of care?

49. A nurse is conducting a respiratory assessment for four clients. Which of the following should the nurse recognize as an abnormal respiratory assessment finding?

50. A nurse is planning care of an adolescent who is postoperative following a lumbar laminectomy. Which of the following interventions should the nurse include in the plan of care?

51. A nurse is caring for a client with an order for 5 units of regular insulin and 10 units of NPH insulin to be mixed together and administered subcutaneously. List the correct order of steps for this procedure.

52. A nurse is planning care for a client who has dysphagia following a stroke. The nurse should initiate a referral for which of the following therapies?

53. A nurse is transcribing new orders for insulin based on a client’s blood glucose readings. The nurse notes that the provider did not write the frequency for checking blood glucose levels on the order sheet.

Which of the following is the appropriate action by the nurse?

54. A nurse is performing a peripheral vascular assessment for a client. When placing the stethoscope on the client’s neck she hears the following sound. This sound indicates which of the following?

55. A nurse on an oncology unit is caring for a client who has tears in his eyes and states, “The doctor just told me that I don’t have long to live.” Which of the following is an appropriate response by the nurse?

56. A nurse is implementing a plan of care for an older adult client who is at risk for falls. Which of the following is an appropriate nursing action?